Chapter : Transition To A Hand
Disruptive technologies bring to a market a very different value proposition than had been available previouslyProducts based on disruptive technologies are typically cheaper, simpler, smaller, and, frequently, more convenient to use.
Erik Brynjolfsson and Andrew McAfee
In November 2007, I was listening to a lecture at an Innovators Conference in Pittsburgh, PA given by the CEO of a start-up named Blue Belt Technologies. It was then that I was presented with the prospect that robotic UKA surgery had the potential to be done without a pre-operative CT scan using a device in development that was considerably less expensive, smaller, and more portable than its predecessor. His presentation dealt primarily with funding considerations for tech start-ups, but I was intrigued by his companys pre-clinical technology â a novel handheld robotic sculpting tool developed by Dr. Tony Digioia and Branko Jaramaz for use in UKA. Afterwards, we spoke extensively about their device, a relatively crude prototype at this stage, that was barely bigger than an arthroscopic shaver. The tool provided a safety mechanism by modulating the speed or exposure of a motorized bur to avoid inadvertent bone resection beyond the plan, and all of the surface mapping was performed intra-operatively without the need for a pre-operative CT scan. It was highly portable which meant it would be more conducive to staggering cases between two operating rooms than the larger Mako unit. Its potential intrigued me.
Knee Replacement After One Month: Range Of Motion
Im currently going to physical therapy 3 times a week and working out at home on my off days. Im able to ride a stationary bike, albeit slowly, take walks a mile long, and do leg strengthening workouts .
Because the swelling has decreased I feel its helped with my ability to bend my knee. Also, my muscles and ligaments are continually being exercised and stretched I would not be doing as well if I wasnt active.
On my 4th visit to the offsite therapy my therapist measured my flexion at 115 degrees. He was pleased and told me I was doing better than the average patient and to keep up the hard work.
Guidelines To Protect Your New Knee Joint
It is very important to KEEP YOUR KNEE STRAIGHT WHILE RESTING, never place a pillow under the back of your knee. Place your heel on a rolled up towel, ottoman, or chair so air is under the knee, push the knee down in extension. This is the most important stretch or exercise after knee replacement, this will help you regain full extension.
We encourage you to walk, get outside, and work on your motion. We strongly encourage the use of ice for the first few weeks after surgery. You will receive a polar care or ice machine which cools the knee which is particularly helpful after therapy.
Lying in Bed: You may lie on either side. Remember never to put a pillow under your knee. Keep your knee out straight while lying down.
Sitting in a Chair: Use a firm, sturdy chair with arm rests.Allow your foot to rest on the floor if you can. Use a cushion or pillow to raise you up, if needed, to facilitate getting out of the chair.
Walking: YOU MAY PLACE ALL OF YOUR WEIGHT ON YOUR KNEE. The physical therapist will teach you to use a walker or crutches when you walk until your knee heals. Most people are walking normally after 3 weeks. Most only use crutches to provide balance and to ensure a normal gait in the first few weeks of recovery. Once a normal gait is established you may discontinue using your crutches, cane, or walker.
Your balance might be shaky for a while, we recommend that you:
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What Insurance Covers Knee Surgery
There are a variety of insurance plans and it is important to check with your specific insurance carrier about coverage for knee surgery. Many insurance plans will cover at least a portion of the cost of knee surgery. Some of the factors that may affect coverage include the reason for the surgery, the type of surgery, and the hospital or facility where the surgery will be performed.
Chronic knee pain is typically caused by strenuous activity or injuries, as well as health conditions such as arthritis. It is critical to replace your knees in order to restore them to their original function. The cost of knee replacement surgery ranges between Rs 50,000 and Rs 2 lakh, which is prohibitively expensive for many Indian families. Your overall health condition, as well as any pre-existing illnesses you may have, are all factors that will influence the cost of knee replacement surgery. It is estimated that the cost of these prosthetics will be around Rs 50000 to Rs 20000, with the majority of this cost coming from importing them from other countries. Check to see if knee replacement is covered under your insurance policy.
What Can I Expect After Surgery
After surgery, you will need to avoid prolonged periods of sitting or standing for a few days until the swelling has subsided.
If you remain moderately active after the procedure, you can expect a faster recovery rate. However, you should avoid physical activity that involves running or other athletic activities for at least a few weeks.
You may need to repeat the surgery if your pain increases after your first surgery. It is because the artificial parts used in your original surgery have failed, and a new set must be implanted.
Because Mako Knee Surgery can relieve the knee jointâs pain, stiffness, and improve its function, patients typically can return to their regular activities as early as a few days after their procedure.
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Third Week Progress After Tkr: Range Of Motion
During the 3rd week post-surgery I began going to my off-site physical therapist. I also began going to a fitness center on my off days.
I began workouts on the exercise bike and seated leg presses with no weight. I also began doing leg lifts with a 3lb weight. The therapist took measurements of both thighs and both knees.
To finish day 1 he gave me a massage around the knee for 10 minutes and then he had me do 20 ankle slides on the table . At the end of the ankle slides, he measured my flexion at 113 degrees and my straight leg at 0 degrees.
Ial Knee Replacement Surgery Recovery Time
Partial knee replacement recovery time depends on the case and the complexity of the operation however, patients are often allowed to bear weight immediately after surgery. Many patients are able to return to activities like driving within two weeks of surgery.
The Mako knee replacement recovery period is thought to be about 30 percent quicker than surgeries unassisted by the technology. Within 5-6 days of the procedure, patients will be encouraged to achieve 90-degree flexion in the knee, and ability to perform a straight leg raise. After 3 weeks, patients should hope to achieve 120 -degree flexion.
At 6 weeks after surgery, knee flexion should be as little as 80% of what is expected for the final outcome, and patients will be able to return to work and progress off of any assisted surface devices.
Muscle strengthening exercises will be recommended at this time, monitored by a physical therapist, to bring patients leg strength and movement back to full or near-full ability. Patients will generally be able to use the treadmill, elliptical, or swim at this time period.
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Is It Right For Me
So if you are a patient with isolated, end-stage, osteoarthritis of the medial compartment of the knee, does it make sense to get a MAKOplasty? Hard to say, that requires a long conversation with your surgeon. And the best route may be to pick a surgeon that you trust and let him pick the tool that is most appropriate for you and that he feels most comfortable with. At the end of the day, the tool that your surgeon feels most comfortable with and has the most experience with is the one that is most likely to lead to the best outcome. The best takeaway is to do our best to not fall prey to effective marketing: robots are great, but may not make the best surgeons.
- MAKOplasty Partial Knee Resurfacing. Patient Education. MAKO Surgical.
- MAKOplasty Partial Knee Resurfacing. Q & A.
How Does It Work
Patients undergoing joint replacement surgery with the Mako can experience less pain and faster recovery times following the procedure. This is because a 3D virtual model of your joint is produced which shows bone structure, disease severity, joint alignment and surrounding bone and tissue. This helps your surgeon to accurately determine optimal size, placement and alignment of your joint replacement implant.
During the procedure, your surgeon will guide Makos robotic arm which is confined to the surgical plan created using your 3D scans. Mako provides real-time data to your surgeon, allowing them to continuously assess the movement and tension of your new joint, and adjust if desired.
The lifespan of your implant should also be increased as more accurately positioned implants last longer.
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Mako: A New Hope For Knee Replacement
In this case, Mako creates a 3D model of your knee joint, which is then used to design a custom-fit replacement. The diseased knee joint is replaced with a metal or plastic frame. The replacement is screwed to your bone with screws and a hinge. The surgery, also known as makoma, is a minimally invasive procedure that uses a robotic arm to guide the replacement through the surgery. This method reduces the amount of damage to surrounding tissues, allowing for a faster and more comfortable recovery. Mako knee replacement is typically less expensive and has a high success rate than other types of knee replacement.
What Is Mako Total Knee Replacement
Mako Total Knee Replacement is a robotic-assisted, minimally-invasive surgery used to treat knee pain and disability. The Mako System uses a robotic arm to precisely remove damaged bone and cartilage and replace it with a metal and plastic implant. The surgery is performed through small incisions, which results in less blood loss, less pain, and a shorter recovery time.
The robotic arm of the Mako Total Knee allows arthritic bone and cartilage to be removed from the knee. Your surgeon can use Makos real-time data to continuously assess the movements and tension of your new joint. A survey of patients 6 months after surgery found that pain scores were lower than those who received conventional joint replacement. When knee replacement surgery is performed, a patient with certain infections, mental disorders, or neuromuscular disorders should consult their doctor first. The lifetime of a joint replacement is not universal and can vary according to each person. A revision is possible as a result of a variety of implant-related risks, including loosening, loosening, and fracture.
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Average Flexion After Knee Replacement
Ive been told that most people dont gain the degree of flexion that Ive gained so quickly. Plus, most people wont gain their full range of motion after surgery.
Comparing yourself to others is a challenge because everyone has a different reason for knee replacement and everyone is in a different physical condition. It also depends on the age of the person.
My general thought would be that initial flexion will likely be between 60-80 degrees and you should aim for 120-130 degrees of flexion within 2 months of surgery. This wont be easy so it will take a lot of effort and determination.
I still have a long way to go. Im ahead of schedule but Ill continue to work to get as much range of motion as possible.
Osteotomy Of The Anterior Tibial Tuberosity
Preferred and used routinely by some authors in knee joints that are difficult to expose, this is an approach that offers excellent exposure.
A midline skin incision is made that extends 810 cm below the ATT. The medial parapatellar arthrotomy begins at a point about 6 cm proximal to the patella and ends distally on the anterior tibial crest.
A trapezoidal osteotomy is performed , leaving the periosteum and lateral muscular attachments intact to the bone fragment . Once the ATT has been overturned, the extensor mechanism can be raised proximally allowing complete exposure of the joint. However, this approach is technically demanding, carries a high risk of complications and should be reserved for selected cases.
The rate of complications occurring with this approach and reported in the literature, such as loss of reduction, impaired synthesis and fracture of the tibia, ranges from 7% to 22% . Wolff reported a risk of loss of reduction if the bone block of the ATT is too short . Whiteside highlighted a risk of fracture of the tibia if the tibial bone block is too long .
Engh and Rorabeck , in 185 revision knee arthroplasties, used a standard approach in 54% of the cases, a quadriceps snip in 29%, a VY approach in 13%, and ATT osteotomy in only 4%.
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How Do I Know If I Need Knee Replacement Surgery
You may need surgery if:
- Your knees are stiff and swollen.
- There is pain throughout the day, even at rest.
- Walking, getting up or climbing stairs is difficult and painful.
- Medication and therapy do not offer enough relief.
- Knee cartilage is so damaged and worn away that you are walking âbone on bone,â in which the bones of the joint are scraping together.
Managing Activities Of Daily Living Following Your Knee Replacement
Chair Transfers: Avoid low recliners and soft couches until otherwise told by Dr. Hickman. Stiff-backed chairs with armrests are ideal to sit in. If the seat is low, you may place 1 or 2 pillows in the chair to elevate the seat and facilitate transfers.
- Back up to the chair until you feel both legs touching the chair.
- Slide your operated leg out in front of you as you reach back with one hand for an armrest.
- Lower yourself slowly, keeping your operated leg straight out. Once seated, bend your knee comfortably, or keep it straight.
- When getting up, scoot your operated leg out in front of you until you can stand on it comfortably.
- Push up using the armrests, keeping your operated leg out in front of you.
Car Transfers: The front seat is preferable because it generally has more leg room, can be adjusted for comfort, and can allow the rider to more easily wear a seat belt.
- Make sure the seat is as far back as possible. Back up to the car with your walker or crutches. Put your operated leg out in front of you.
- Lower yourself slowly to the seat. You may roll the window down and use the car door frame, along with the headrest, to support yourself as you sit.
- Scoot back into the seat, then swing your legs into the car. If the seat is low, recline the back slightly or put a pillow on the seat to sit on.
- To get in the back seat in a semi-reclining position. You will need to use your arms and non-operative leg to scoot yourself back farther onto the seat.
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What Is A Mako Robotic Partial Knee Replacement
A Mako Robotic Partial Knee Replacement Surgery is a partial knee replacement performed with a highly precise robotic installation system. This robotic system is one of the tools Dr. Buechel uses to precisely prepare the bones for the placement of the knee implants. He has been using this system for 12 years for partial knee replacements.
Pre-Operative Planning Tool
This system includes a highly evolved software package that allows Dr. Buechel to perform precision pre-operative planning of the intended implants sizes, alignments, and positions based on 3-Dimensional CT data of your hip, knee and ankle.
What Do These Differences Mean
Pre-operative CT scans are not a standard requirement for knee replacements, this represents an extra step for the patient, the surgeon and the healthcare system. This extra procedure can cost patients additional time, money and exposure to radiation.
Navio partial knee replacement has an open approach to implant selection which makes available more choices for surgeons to use. The technology provides a collaborative approach to solving joint pain and returning patients to more normal function.
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Gosford Private Hospital Introduces New Mako Robot
The MAKO Robot is being introduced for the first time on the Central Coast by Gosford Private Hospital, which will allow it to provide better outcomes for patients undergoing both partial and total knee and hip replacement surgeries. TKA procedures are estimated to cost between $12,380 and $16,094 for government-covered insurance, with private and commercial payers covering the majority of the cost. By 2030, the number of TKAs is expected to exceed 1 million, with 50% performed on people under the age of 65. The Stryker Mako robot costs $1.25 million to purchase itself, and an additional $100,000 in service contracts is required every year. Each case is equipped with $1,000 in extra disposable equipment. The cost of the implant varies, but it typically ranges from $5,500 to $8,000 USD. Because of its ability to protect soft tissue and ligaments from damage, the Mako joint replacement is a good choice for patients who require knee replacement, and a clinical study found that patients who had the joint replaced reported lower pain scores 6 months after surgery than patients who did not.
How Long Do Total Knee Replacements Last
Traditional TKR studies have reported that 97.8 percent last for up to 20 years. The Mako knee replacement technique was first performed in the U.S. in 2017.
The longevity of joint replacements depends on a patients activity level and weight. Increased precision with the Mako procedures increases the implants life expectancy.
Experts currently estimate that Mako TKRs last about ten to sixteen years. This timeframe will likely change with prolonged use.
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